An Overview of Borderline Personality Disorder (BPD)

What Is BPD???

Borderline personality Disorder (BPD), is a serious mental illness that centres on an inability to manage emotions effectively.

There is a long-term pattern of abnormal behaviour characterized by:

• Unstable relationships with other people

• Unstable sense of self

• Unstable emotions

Everyone can most likely recognize some of the BPD traits to varying degree. It is how many of the traits you have and to what degree that the traits effect your daily life, that qualifies you for a diagnosis of Borderline Personality Disorder.

The term ‘borderline’ refers to the now outdated but once widely accepted notion that sufferers exist on the borderline between psychosis and neurosis.

 

Borderline Personality Disorder Criteria from the DSM-5

You might be given a diagnosis of BPD if you experience A pervasive pattern of instability of interpersonal relationships, self-image, and affects (emotions), impulsivity, beginning by early adulthood and present in a variety of contexts, and they’ve lasted for a long time (over a year) and have a real impact on your daily life. You must exhibit at least five of the following :

(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

(3) identity disturbance: markedly and persistently unstable self image or sense of self

(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

(5) recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour

(6) affective (emotional) instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

(7) chronic feelings of emptiness

(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

(9) transient, stress–related paranoid ideation or severe dissociative symptoms

 

Criteria Simplified:

1. Feeling very worried about people abandoning you, and willing to do anything to stop that happening.

2. Having very intense emotions that last from a few hours to a few days and can change quickly. Example, from feeling very happy and confident in the morning to feeling low and sad in the afternoon).

3. Lacking a strong sense of who you are which can fluctuate depending upon who you’re with.

4. Finding it very hard to make and/or keep stable relationships.

5. Acting impulsively and doing things that could harm you (such as binge eating, using drugs or driving dangerously).

6. Having suicidal thoughts or adopting self-harming behaviour.

7. Feeling empty and lonely much of the time.

8. Getting VERY angry, where it becomes a struggle to control your anger.

9. When very stressed, sometimes you might:
– feel paranoid
– have psychotic experiences, such as seeing or hearing things that other people don’t
– feel numb or ‘checked out’ and not remember things properly after they’ve happened.

– Go into a Dissociative state: Depersonalization or derealization.

Because one only needs to meet five out of these nine symptoms to be diagnosed with borderline personality disorder, there can be many varying types of this disorder, meaning not everyone’s BPD experiences are identical.

 

Concurrent Disorders

BPD usually is seen existing along with other disorders. Some of which include:

Anorexia nervosa, Bipolar 2, PTSD (and other anxiety related disorders), Obsessive Compulsive Disorder, Substance abuse and others.

 

Misdiagnosed

Some of the time, BPD can be misdiagnosed as Bipolar Disorder due to the extreme highs and lows of moods. In Bipolar Disorder, mania and depression are cyclic, determined by time. Individuals with BPD, however, have problems regulating their thoughts and emotions and are easily triggered. These internal/external events in turn triggers the mood swings. The differences in BPD mood swings is that with BPD they are triggered by events rather than time––and they can happen several times throughout a day. They can also cause episodes of euphoria and dysphoria similar to mania and depression. The reckless behaviour seen in BPD personalities can also be mistaken for mania.

Two Principle Fears in Relationships:

1. Fear of Abandonment/Rejection by the other person

2. Fear of Engulfment/being smothered by the others emotional needs

*One fear may predominate, or they may alternate depending on the situation.

Engulfment can refer to a tendency to over-immerse yourself in relationships and depend on the other to meet ALL of your needs, even demanding that they do so.

Engulfment happens when we have negative core beliefs about ourselves. These core beliefs are the assumptions we make about ourselves and the world. We make them when we are a child and then continue to see them as factual until we learn to question and change them.

 If you are prone to engulfment in your relationship, you might have core beliefs like:

• It’s selfish to put myself before others
• I have to earn and deserve love
• It’s my job to love others
• I am responsible for other people’s happiness
• If I don’t do what other people want, they will reject me
• Nobody would like the real me so I have to be what the other person wants
• I only exist and have value if others love me
• I am unloveable
• I am not good enough

These sorts of beliefs, or what I like to call lies in disguise, can be learned from childhood trauma such as, abuse or neglect or maybe from the loss of a parent/loved one,

 

Different Relationship Dynamics of Engulfment and Abandonment:

• You may fear being in a relationship because you once were on the receiving end of the engulfment and were expected to fill every need and demand of the one whom you were in a relationship with.  This can result in developing an avoidant attachment style.
• You may fear of getting too close because once you do, you’re afraid you will smother/engulf the other and as a result, they will reject you, therefor you push them away first.

 

 

Triggers & Relationships

Since a core aspect of Borderline PD is an intense fear of rejection and abandonment interpersonal relationships suffer greatly. This fear of abandonment in most cases, is derived from a unhealthy or traumatic upbringing with a dominant pattern of neglect/abuse by early caregivers. This fear can present in behaviours that seem to be a catch-22––a damned if you do, damned if you don’t scenario. These behaviours typically frighten or push people away. My own experiences bears this out as I have expressed to my partner “I need love the most when I am most hardest to love”.

People with Borderline PD crave love and acceptance, but push people away because they fear getting too close – closeness gives rise to a sense of vulnerability.

Idealization & Devaluation: Is when the person with Borderline PD first places someone on a pedestal and then manifests hate/anger, tearing them down, playing an involuntary game of “I hate you, don’t leave me” emotional tug of war that feels uncontrollable.

 

Role of Belief Systems

An individual with BPD needs constant reassurance and validation, they need to know it is safe to be vulnerable and that you will still love them – a love without conditions. This can be challenging because the behaviours displayed by the person with BPD can break down relationships, sometimes beyond repair. It becomes a vicious cycle – the one with BPD believes deep down you will abandon/reject them, and so they push you away (whilst hoping you stay) When the relationship fails, it confirms that original belief that you would abandon them – they prove it to be true (unconsciously). This belief may become a self-fulfilling prophecy throughout their life.

 

Lack of Solid Identity

Changing jobs, friends, lovers, goals, hobbies, appearances and so forth are common of the person with bpd, reflecting their effort to find a sense of identity and belonging. They can often act like a chameleon around others due to searching for a sense of self in others. Low self-esteem also plays a role alongside the lack of identity. Since the person with Borderline pd doesn’t have good self esteem, their self perception and value of self is based on a recent event/experience be it negative or positive.

 

Avoidance of Being Alone

A sense of darkness, emptiness and boredom lingers within, and when they are alone, these feelings and dark thoughts tend to become overwhelming. The person with BPD will become frantic in their efforts to avoid being alone (and to avoid feeling), sometimes fleeing to bars to be around people, or adopting self-harm behaviours to cope with their feelings.

 

Internalizing VS Acting out

People with BPD experience a lot of emotional anguish. It is said that these individuals feel emotions more intensely than the average person. It is likened to a person walking around with third degree burns – They are extremely sensitive. They strive to gain a sense of relief from the pain by employing self-destructive tendencies. These can look very different. Some individuals also known as “the quiet Borderline” internalize the pain and often hide their destructive behaviour. The most common behaviour would be self harm. Cutting one’s skin with sharp objects, (not for suicidal purposes) or digging nails into their skin. Excessive rubbing/skin picking or hair pulling can be symptoms as well. The acting-out Borderline’s are much more “in your face” and act out in aggressive, reckless or promiscuous ways.

 

Distorted Thinking Patterns

People with BPD can experience distorted thinking patterns, some of which include:

 

1. All or nothing thinking – all good or all bad (Splitting)

• Thoughts about self. Either I am well, or I am despairing and want to die.

• Either I am an all-good or an all-bad person.

• Either I am beautiful or I am ugly.

• If I have a good day I am successful, positive – if I have a bad day I am worthless and self shaming.

• These thoughts are often at opposite ends of a scale with no middle ground. Also described as black and white thinking – no grey area.

2. Thinking with Feelings

This is when we feel something strongly, we think it must be true.

“I feel worthless, therefore, I am worthless”

 

GOOD NEWS!

80% of people with BPD recover with treatment

With specialized therapy, most people with Borderline Personality Disorder find their symptoms are reduced and their lives are improved. Although not all the symptoms may ease, there is often a major decrease in problem behaviours and suffering. Under stress, some symptoms may return. When this happens, people with BPD should return to therapy and other kinds of support.

 

Treatment

Some types include:

• Dialectical behaviour Therapy (DBT) – Skills training (Emotions/Distress/Acceptance/Mindfulness)
• Cognitive behaviour Therapy (CBT) – Changing Thoughts
• Transference focused Therapy (SFT)
• Schema Therapy (SFT)
• Eye Movement Desensitization and Reprocessing (EMDR) – Trauma/PTSD

*For concurrent disorders, a separate treatment plan may (and most likely) be needed aside from the treatment of bpd.

Self Help

If you are looking for some self guided information (aside from other therapies you may be in, or may not have the opportunity to have), I have used many books all throughout my healing journey to keep me actively engaged, educated and moving forward in my recovery of BPD.

Upon my first admission to hospital it was recommended to me by the Psychiatrist whom diagnosed me with BPD at that time, to read a book called: I Hate you—Don’t Leave me Understanding the borderline personality

This book gave me my first understandings of exactly what my diagnoses was, it became the foundation to which to build on in the start of my recovery.

You can find this book here

If you are someone who doesn’t live with the disorder personally, but are affected by the disorder through a loved one, it may be helpful for you to read: Stop walking On Eggshells, Taking your life back when someone you care about has Borderline Personality:

You can find this book here

Borderline Personality Disorder is NOT the end, there is much hope for the one who has the disorder and for the one who loves someone with it. You CAN be successful with your day to day life and relationships.

I am living proof of this statement.

I hope you find these resources helpful. Sending my best wishes to you!

 

Warmly,

Oriana

xo

Keep healing, keep growing, keep finding your truth

 

*Statistics source: here